Coronary artery bypass grafting without cardiopulmonary bypass through sternotomy and minimally invasive procedure.
Coronary artery bypass grafting without cardiopulmonary bypass (CPB) is now an accepted technique of myocardial revascularization in a special subset of patients. This paper presents our total experience in 1761 cases operated on since September 1981 until April 1997 out of a total of 9164 patients revascularized with the conventional technique during this period of time. Among the 1761 patients, 53 (3%) were operated on by minimally invasive surgery. The overall applicability was 19.2% and the most common grafted arteries were left anterior descending artery (LAD), right coronary artery (RCA), and diagonal. Results indicate that the operation can be performed with an acceptable mortality (2.3%) and that all types of arterial conduits can be used. The incidence of major postoperative complications were significantly lower in this group of patients when compared with our patients receiving conventional myocardial revascularization. Most importantly there was decrease cost when the procedure was used because no extracorporeal circulation cardioplegia sets or other cannulas were used. We conclude based on in this fifteen years experience that the technique of myocardial revascularization in a beating heart is justified, safe and can offer to selected patients the best option of coronary insufficiency surgical treatment.
Buffolo
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Department of Cardiovascular Surgery, Paulista School of Medicine, Federal University of São Paulo, Brazil.
Gerola
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LR
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001161:Arteriosclerosis / Q000453:epidemiology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000191:economics / Q000601:surgery*; D003404:Creatinine; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D009203:Myocardial Infarction / Q000453:epidemiology; D011446:Prospective Studies; D012044:Regression Analysis; D012086:Reoperation; D012307:Risk Factors; D017678:Sex Distribution; D013249:Sternum / Q000601:surgery; D015996:Survival Rate; D014654:Vascular Patency
D003404:Creatinine